Provider Demographics
NPI:1477017267
Name:PIERCE, TAMELLA (MS)
Entity Type:Individual
Prefix:
First Name:TAMELLA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TAMELLA
Other - Middle Name:
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:8963 W ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7998
Mailing Address - Country:US
Mailing Address - Phone:623-277-0857
Mailing Address - Fax:
Practice Address - Street 1:338 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-2402
Practice Address - Country:US
Practice Address - Phone:602-688-6238
Practice Address - Fax:602-272-5614
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20232101Y00000X
AZLAC-15660101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty